Provider Demographics
NPI:1700366903
Name:REBECCA GILLETT COUNSELING LLC
Entity Type:Organization
Organization Name:REBECCA GILLETT COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:GILLETT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, MS
Authorized Official - Phone:847-528-9393
Mailing Address - Street 1:939 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:GLENCOE
Mailing Address - State:IL
Mailing Address - Zip Code:60022-1451
Mailing Address - Country:US
Mailing Address - Phone:847-528-9393
Mailing Address - Fax:
Practice Address - Street 1:666 DUNDEE RD STE 1302
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-2736
Practice Address - Country:US
Practice Address - Phone:847-528-9393
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-16
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0164641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty